Population Salt Intake Research Articles

Salt intake among women in an Urban resettlement colony of Delhi

Monitoring of population salt intake is essential for compliance with the WHO target of a 30% relative reduction in mean population salt intake. This study was conducted to estimate the daily salt intake and find the associated variables among adult women in an urban resettlement colony of Delhi. In this community-based cross-sectional study, 426 women aged 20-59 years from an urban resettlement colony were randomly selected. Sociodemographic details, anthropometric measurements, blood pressure, and morning spot urine samples were obtained. INTERSALT equation was used to estimate the 24-h salt intake from spot urine sodium. Association of salt intake with related variables was studied using t-test/analysis of variance, and P < 0.05 was considered to be significant. A total of 426 women participated in the study, and 381 participants' urine samples could be collected. The study participants' mean age (standard deviation [SD]) was 34.5 (9.4) years. The mean salt intake (SD, 95% confidence interval) of the participants calculated using the INTERSALT equation was 7.6 (1.7, 7.5-7.8) g/day. The salt intake was significantly associated with educational status, occupation, marital status, socioeconomic status, blood pressure, and waist circumference. Waist circumference was found to have a significant positive linear relationship with daily salt intake. The daily salt intake of this population was well above the recommendation and had a positive linear relationship with waist circumference. Reduction in daily salt intake is a must to control the epidemic of hypertension.

Estimating mean population salt intake in Fiji and Samoa using spot urine samples

BackgroundThere is an increasing interest in finding less costly and burdensome alternatives to measuring population-level salt intake than 24-h urine collection, such as spot urine samples. However, little is known about their usefulness in developing countries like Fiji and Samoa. The purpose of this study was to evaluate the capacity of spot urine samples to estimate mean population salt intake in Fiji and Samoa.MethodsThe study involved secondary analyses of urine data from cross-sectional surveys conducted in Fiji and Samoa between 2012 and 2016. Mean salt intake was estimated from spot urine samples using six equations, and compared with the measured salt intake from 24-h urine samples. Differences and agreement between the two methods were examined through paired samples t-test, intraclass correlation coefficient analysis, and Bland-Altman plots and analyses.ResultsA total of 414 participants from Fiji and 725 participants from Samoa were included. Unweighted mean salt intake based on 24-h urine collection was 10.58 g/day (95% CI 9.95 to 11.22) in Fiji and 7.09 g/day (95% CI 6.83 to 7.36) in Samoa. In both samples, the INTERSALT equation with potassium produced the closest salt intake estimate to the 24-h urine (difference of − 0.92 g/day, 95% CI − 1.67 to − 0.18 in the Fiji sample and + 1.53 g/day, 95% CI 1.28 to 1.77 in the Samoa sample). The presence of proportional bias was evident for all equations except for the Kawasaki equation.ConclusionThese data suggest that additional studies where both 24-h urine and spot urine samples are collected are needed to further assess whether methods based on spot urine samples can be confidently used to estimate mean population salt intake in Fiji and Samoa.

Estimation of the salt intake distribution of Dutch kidney transplant recipients using 24-h urinary sodium excretion: the potential of external within-person variance

There is growing interest in assessing a population's prevalence of inadequate nutrient intake using biomarkers. However, within-person variation is generally ignored because repeated data collections are considered costly and burdensome. The study aimed to show the importance of estimating, from repeated 24-h urine collections, a population's habitual salt intake and to explore the potential of using the ratio of within-person variance to total variance from an external source (W:T variance) with single 24-h urine collection. Salt intake was predicted from data for 24-h urinary sodium excretion in adult kidney transplant recipients in 1992-1997 (n=432) and 2006-2011 (n=1159). The salt intake distribution of single-day measurements was compared with estimates from multiple 24-h urine collections, which were statistically corrected for within-person variance. Habitual salt intake was also estimated using single-day measurements and external variance estimates. From each distribution, the proportion below specified cut-off values was estimated. In 2006-2011 the average habitual salt intake was 10.6 g/d (men) and 8.5 g/d (women); in 1992-1997 these values were 8.6 g/d and 7.5 g/d, respectively. The proportion with salt intake <6 g/d was 5% and 13% in 2006-2011 and 22% and 28% in 1992-1997, respectively, for men and women. Correction for within-person variance significantly narrowed the salt intake distribution-the proportion with salt intake <6 g/d was overestimated by 3-13 percentage points using single-day data. Sensitivity analyses showed the importance of a sufficient sample size for estimating variance components. Variation of the W:T variance showed up to 40 percentage points deviation in the proportion with intakes below a specified cut-off value. To estimate a population's salt intake distribution, it is important to correct 24-h urinary sodium excretion for within-person variance. Predicting habitual salt intake distribution using single-day measurements with external variances is promising; a sensitivity analysis is recommended to show the effect of different external variances.

SODIUM AND POTASSIUM INTAKE IN ADULTS IN PODGORICA, MONTENEGRO

Objective: Excess salt (sodium chloride) and inadequate potassium intakes are responsible for high blood pressure in populations and they are associated with higher cardiovascular disease (CVD). In Montenegro, CVD is the leading cause of death and disability. Moreover, there is no survey that has directly measured salt and potassium consumption in Montenegro. The aim is to provide reliable estimates of population salt and potassium intakes and to explore knowledge, attitudes and behaviour (KAB) towards dietary salt, in a representative sample of the adult population of Podgorica, the capital city of Montenegro. Design and method: Random samples of registered adult population were obtained from 6 primary care centres in Podgorica. After informed consent, invited participants attended a screening session. Demographic, anthropometric and physical measurements were obtained with standardized methods. Dietary salt and potassium intakes were assessed by urinary sodium (UNa) and potassium (UK) determination in 24 h urine collections. Creatinine was measured to estimate the accuracy of the collection. KAB towards salt consumption were collected by standard questionnaire. Results: After quality control, six hundred and thirty-nine (285 men, 25–65 years) were included in the analysis (response rate 63%). Mean UNa was 186.5 (SD 90.3) mmol/day, equivalent to 11.6 g of salt/day, and potassium excretion 62.5 (26.2) mmol/day, equivalent to 3.2 g/day. Men had higher UNa and UK compared to women. Only 7% of them had a salt intake below the WHO recommended target of 5 g/day, and 13% ate enough potassium (>90 mmol/day). The majority (86%) knew that high salt causes ill-health. However, only 44% thought it would be useful to reduce salt consumption. Conclusions: Salt consumption is high, and potassium consumption is low, in men and women living in Podgorica. There is an urgent need for intensive awareness campaigns and health promotion to improve the take up of preventive strategies aiming at reducing salt consumption, whilst at the same time increasing potassium intake. Furthermore, additional policy options involving food manufacturers, distributors and outlets should be considered to reduce the hidden salt in processed food.

Dietary Sources of Salt in Low- and Middle-Income Countries: A Systematic Literature Review.

Rapid urbanization in low- and middle-income countries (LMICs) is transforming dietary patterns from reliance on traditional staples to increased consumption of energy-dense foods high in saturated fats, trans fats, sugars, and salt. A systematic literature review was conducted to determine major food sources of salt in LMICs that could be targeted in strategies to lower population salt intake. Articles were sourced using Medline, Web of Science, Scopus, and grey literature. Inclusion criteria were: reported dietary intake of Na/salt using dietary assessment methods and food composition tables and/or laboratory analysis of salt content of specific foods in populations in countries defined as low or middle income (LMIC) according to World Bank criteria. Of the 3207 records retrieved, 15 studies conducted in 12 LMICs from diverse geographical regions met the eligibility criteria. The major sources of dietary salt were breads, meat and meat products, bakery products, instant noodles, salted preserved foods, milk and dairy products, and condiments. Identification of foods that contribute to salt intake in LMICs allows for development of multi-faceted approaches to salt reduction that include consumer education, accompanied by product reformulation.

Mean Dietary Salt Intake in Vanuatu: A Population Survey of 755 Participants on Efate Island.

Non-communicable diseases are responsible for 63% of global deaths, with a higher burden in low- and middle-income countries. Hypertension is the leading cause of cardiovascular-disease-related deaths worldwide, and approximately 1.7 million deaths are directly attributable to excess salt intake annually. There has been little research conducted on the level of salt consumption amongst the population of Vanuatu. Based on data from other Pacific Island countries and knowledge of changing regional diets, it was predicted that salt intake would exceed the World Health Organization’s (WHO) recommended maximum of 5 g per day. The current study aimed to provide Vanuatu with a preliminary baseline assessment of population salt intake on Efate Island. A cross-sectional survey collected demographic, clinical, and urine data from participants aged 18 to 69 years in rural and urban communities on Efate Island in October 2016 and February 2017. Mean salt intake was determined to be 7.2 (SD 2.3) g/day from spot urine samples, and 5.9 (SD 3.6) g/day from 24-h urine samples, both of which exceed the WHO recommended maximum. Based on the spot urine samples, males had significantly higher salt intake than females (7.8 g compared to 6.5 g; p < 0.001) and almost 85% of the population consumed more than the WHO recommended maximum daily amount. A coordinated government strategy is recommended to reduce salt consumption, including fiscal policies, engagement with the food industry, and education and awareness-raising to promote behavior change.

Potential impact of a modest reduction in salt intake on blood pressure, cardiovascular disease burden and premature mortality: a modelling study

ObjectiveTo assess the potential impact of reduction in salt intake on the burden of cardiovascular disease (CVD) and premature mortality in Cameroon.MethodsUsing a multicohort proportional multistate life table model with...

Sodium and Potassium Intake, Knowledge Attitudes and Behaviour Towards Salt Consumption Amongst Adults in Podgorica, Montenegro.

Excess salt and inadequate potassium intakes are associated with high cardiovascular disease (CVD). In Montenegro, CVD is the leading cause of death and disability. There is no survey that has directly measured salt and potassium consumption in Montenegro. The aim is to estimate population salt and potassium intakes and explore knowledge, attitudes and behaviour (KAB), amongst the adult population of Podgorica. Random samples of adults were obtained from primary care centres. Participants attended a screening including demographic, anthropometric and physical measurements. Dietary salt and potassium intakes were assessed by 24 h urinary sodium (UNa) and potassium (UK) excretions. Creatinine was measured. KAB was collected by questionnaire. Six hundred and thirty-nine (285 men, 25–65 years) were included in the analysis (response rate 63%). Mean UNa was 186.5 (SD 90.3) mmoL/day, equivalent to 11.6 g of salt/day and potassium excretion 62.5 (26.2) mmoL/day, equivalent to 3.2 g/day. Only 7% of them had a salt intake below the World Health Organization (WHO) recommended target of 5 g/day and 13% ate enough potassium (>90 mmoL/day). The majority (86%) knew that high salt causes ill-health. However, only 44% thought it would be useful to reduce consumption. Salt consumption is high and potassium consumption is low, in men and women living in Podgorica.

A13673 Estimating mean population salt intake in Fiji and Samoa using spot urine samples

A13673 Estimating mean population salt intake in Fiji and Samoa using spot urine samples

Abstract P214: Serum Glucocorticoid Kinase 1 and Sympathetic Nerve Activity in Salt-Sensitive Hypertension.

Salt-sensitive hypertension affects nearly 50% of the population and reducing salt intake decreases blood pressure and cardiovascular events in the general population. The precise mechanism of how dietary salt contributes to blood pressure (BP) elevation, renal injury, and cardiovascular disease remains unclear. Substantial evidence supports a role of increased sympathetic output in salt-dependent hypertension and this promotes renal inflammation and dysfunction. It has been shown that salt accumulates in the interstitium of hypertensive humans and animals and drives immune cells toward a proinflammatory phenotype through the salt sensing kinase serum/glucocorticoid kinase 1 (SGK1). We have also shown an important role of monocytes and monocyte-derived dendritic cells in hypertension. In this study, we tested the hypothesis that SGK1 in myeloid CD11c + cells promote salt-sensitive hypertension by increasing sympathetic outflow. To test this hypothesis, we created mice lacking SGK1 in CD11c + cells (SGK1 CreCD11c mice) and used SGK1 fl/fl mice as controls. To induce salt-sensitivity, mice received 0.5 mg/ml of N-Nitro-L-arginine methyl ester hydrochloride (L-NAME) in the drinking water for 2 weeks. This was followed by a 2-week washout period and then a 4% high salt diet for 3 weeks. BP was monitored using telemetry. We found that BP elevation during high salt feeding was significantly attenuated in SGK1 CreCD11c mice compared to SGK1 fl/fl mice (125 ± 1 vs. 141 ± 1 mmHg; p &lt; 0.01). SGK1 CreCD11c mice had a significant reduction in CD45 + , CD3 + , CD4 + CD8 + and CD19 + cells in the kidney compared to SGK1 fl/fl mice as assessed by flow cytometry (p &lt; 0.05). Interestingly, on high salt, SGK1 CreCD11c mice had a significant reduction in heart rate (HR) compared to SGK1 fl/fl mice (528 ± 2 vs. 592 ± 7 bpm; p = 0.006). Microglial cells of the brain express CD11c, and we found that the reduction in HR was associated with a marked reduction in HR variability in SGK1 CreCD11c mice compared to SGK1 fl/fl mice (1.65 ± 0.38 vs. 3.00 ± 0.57; p = 0.0018), indicating a reduction in sympathetic outflow. Our data indicate that SGK1 in CD11c + myeloid cells and likely those of the central nervous system, modulate BP and sympathetic outflow promoting the pathogenesis of salt-sensitive hypertension.

Process evaluation of Samoa\u2019s national salt reduction strategy (MASIMA): what interventions can be successfully replicated in lower-income countries?

BackgroundEvidence for recommended interventions to reduce population salt intake come from high-income countries, but it is unknown if these can be successfully replicated in low- and middle-income countries. This process evaluation investigated the reach, dose/adoption, fidelity, cost, and context of a national salt reduction program of interventions in Samoa.MethodsMonitoring and Action on Salt in Samoa (MASIMA) was a pre- and post-intervention study of a government-led strategy to lower population salt intake comprising awareness campaigns, community mobilization and policy and environmental changes. Data relating to the five process evaluation dimensions were collected from routinely collected data, a post-intervention survey and stakeholder interviews. Chi-squared tests assessed differences in quantitative survey responses among groups. Thematic analysis of qualitative interview responses was undertaken and triangulated with the quantitative data.ResultsAwareness campaigns, school nutrition standards, and community mobilization interventions were implemented with moderate reach and fidelity. Higher than expected costs of campaigns and limited opportunity (one-off) to mobilize community leaders to disseminate salt reduction messages were key implementation challenges, which meant intervention dose was low. Environmental-level initiatives including engagement with the food industry to voluntary reduce salt in foods and the introduction of salt-related regulations were more challenging to implement within 18-months, particularly given the delay in the passing of the Food Act which provides for enforcement of regulations. Contextual factors that hindered the interventions’ mechanism of effect include the food culture, higher cost, and lower availability of healthy low-salt foods relative to unhealthy foods and salty taste preference.ConclusionAlthough individual and community-based interventions helped increase awareness about the importance of salt reduction in Samoa, legislative backing was needed to alter the food environment to achieve population reduction in salt intake. It was not possible to engage the food industry to lower salt in foods through a voluntary approach in Samoa’s current context, although such initiatives were successful in some high-income countries. Future individual and environmental-level interventions to reduce salt intake need to address the contextual influences of food choices. In Samoa, this means salt reduction strategies need to ensure consuming lower salt is affordable, widely available, and perceived as flavorsome.

Role of salt intake in prevention of cardiovascular disease: controversies and challenges.

Strong evidence indicates that reduction of salt intake lowers blood pressure and reduces the risk of cardiovascular disease (CVD). The WHO has set a global target of reducing the population salt intake from the current level of approximately 10 g daily to <5 g daily. This recommendation has been challenged by several studies, including cohort studies, which have suggested a J-shaped relationship between salt intake and CVD risk. However, these studies had severe methodological problems, such as reverse causality and measurement error due to assessment of salt intake by spot urine. Consequently, findings from such studies should not be used to derail vital public health policy. Gradual, stepwise salt reduction as recommended by the WHO remains an achievable, affordable, effective, and important strategy to prevent CVD worldwide. The question now is how to reduce population salt intake. In most developed countries, salt reduction can be achieved by a gradual and sustained reduction in the amount of salt added to food by the food industry. The UK has pioneered a successful salt-reduction programme by setting incremental targets for >85 categories of food; many other developed countries are following the UK's lead. In developing countries where most of the salt is added by consumers, public health campaigns have a major role. Every country should adopt a coherent, workable strategy. Even a modest reduction in salt intake across the whole population can lead to a major improvement in public health and cost savings.

Knowledge and behaviors regarding salt intake in Mozambique.

Health education and regulatory measures may contribute to lower population salt intake. Therefore, we aimed to describe knowledge and behaviors related to salt intake in Mozambique. A cross-sectional evaluation of a representative sample of the population aged 15-64 years (n = 3116) was conducted in 2014/2015, following the Stepwise Approach to Chronic Disease Risk Factor Surveillance, including a 12-question module for evaluation of dietary salt. Three dimensions were identified in the questionnaire, named "self-reported salt intake", "knowledge of health effects of salt intake", and "behaviors for control of salt intake". A total of 7.4% of the participants perceived that they consumed too much/far too much salt and 25.9% reported adding salt/salty seasoning often/always to prepared foods. The proportion considering that it was not important to decrease the salt contents of their diet was 8%, and 16.9% were not aware that high salt intake could be deleterious for health. Prevalences of lack of behaviors for reducing salt intake ranged from 74.9% for not limiting consumption of processed foods, to 95% for not buying low salt alternatives. There were few differences according to socio-demographic variables, but awareness of hypertension was, in general, associated with better knowledge and less frequent behaviors likely to contribute to a high salt intake. Most Mozambicans were aware that high salt intake can cause health problems, but the self-reported salt intake and behaviors for its control show an ample margin for improvement. This study provides evidence to guide population level salt-reducing policies.

How will South Africa’s mandatory salt reduction policy affect its salt iodisation programme? A cross-sectional analysis from the WHO-SAGE Wave 2 Salt & Tobacco study

ObjectiveThe WHO’s global targets for non-communicable disease reduction recommend consumption of<5 g salt/day. In 2016, South Africa was the first country to legislate maximum salt levels in processed foods. South...

Salt intake and dietary sources of salt on weekdays and weekend days in Australian adults.

To assess if there is a difference in salt intake (24 h urine collection and dietary recall) and dietary sources of salt (Na) on weekdays and weekend days. A cross-sectional study of adults who provided one 24 h urine collection and one telephone-administered 24 h dietary recall. Community-dwelling adults living in the State of Victoria, Australia. Adults (n 598) who participated in a health survey (53·5 % women; mean age 57·1 (95 % CI 56·2, 58·1) years). Mean (95 % CI) salt intake (dietary recall) was 6·8 (6·6, 7·1) g/d and 24 h urinary salt excretion was 8·1 (7·8, 8·3) g/d. Mean dietary and 24 h urinary salt (age-adjusted) were 0·9 (0·1, 1·6) g/d (P=0·024) and 0·8 (0·3, 1·6) g/d (P=0·0017), respectively, higher at weekends compared with weekdays. There was an indication of a greater energy intake at weekends (+0·6 (0·02, 1·2) MJ/d, P=0·06), but no difference in Na density (weekday: 291 (279, 304) mg/MJ; weekend: 304 (281, 327) mg/MJ; P=0·360). Cereals/cereal products and dishes, meat, poultry, milk products and gravy/sauces accounted for 71 % of dietary Na. Mean salt intake (24 h urine collection) was more than 60 % above the recommended level of 5 g salt/d and 8-14 % more salt was consumed at weekends than on weekdays. Substantial reductions in the Na content of staple foods, processed meat, sauces, mixed dishes (e.g. pasta), convenience and takeaway foods are required to achieve a significant consistent reduction in population salt intake throughout the week.

Salt consumption by Australian adults: a systematic review and meta-analysis.

Salt reduction is a public health priority because it is a leading contributor to the global burden of disease. As in Australia there is uncertainty about the current level of salt intake, we sought to estimate current levels. Random effects meta-analysis of data from 31 published studies and one unpublished dataset that reported salt or sodium consumption by Australian adults on the basis of 24-hour urine collections or dietary questionnaires. MEDLINE (via Ovid) and EMBASE (to August 2016). Thirty-one published studies and one unpublished dataset (1989-2015; 16 836 individuals) were identified. The mean weighted salt consumption estimated from 24-hour urine collections was 8.70 g/day (95% CI, 8.39-9.02 g/day); after adjusting for non-urinary salt excretion, the best estimate of salt intake in Australia is 9.6 g/day. The mean weighted intake was 10.1 g/day (95% CI, 9.68-10.5 g/day) for men and 7.34 g/day (95% CI, 6.98-7.70 g/day) for women. Mean weighted consumption was 6.49 g/day (95% CI, 5.94-7.03 g/day) when measured with diet diaries, 6.76 g/day (95% CI, 5.48-8.05 g/day) when assessed with food frequency questionnaires, and 6.73 g/day (95% CI, 6.34-7.11) when assessed by dietary recall. Salt intake had not decreased between 1989 and 2015 (R2 = -0.02; P = 0.36). Salt intake in Australian adults exceeds the WHO-recommended maximum of 5 g/day and does not appear to be declining. Measuring salt intake with methods based on self-reporting can substantially underestimate consumption. The data highlight the need for ongoing action to reduce salt consumption in Australia and robust monitoring of population salt intake.

Assessment of salt concentration in bread commonly consumed in the Eastern Mediterranean Region

Hypertension is the most important cardiovascular risk factor in the World Health Organization (WHO) Eastern Mediterranean Region. Excessive salt and sodium intake is directly related to hypertension, and its reduction is a priority of WHO. Bread is the leading staple food in the Region; therefore, reducing the amount of salt added to bread could be an effective measure for reducing salt intake. The study sought to determine the levels of sodium and salt in locally produced staple bread from 8 countries in the Region. Bread samples were collected randomly from bakeries located in the capital cities of the selected countries. The samples were analysed for sodium content using atomic absorption spectroscopy. The mean salt content of breads varied from 4.28 g/kg in Jordan to 12.41 g/kg in Tunisia. The mean salt and sodium content in bread for all countries was 7.63 (SD 3.12) and 3.0 (SD 1.23) g/kg, respectively. The contribution of bread to daily salt intake varied considerably between countries, ranging from 1.3 g (12.5%) in Jordan to 3.7 g (33.5%) in Tunisia. Interventions to reduce population salt intake should target reduction of salt in bread in all countries. The amount of salt added to bread should be standardized and relevant legislation developed to guide bakers. Setting an upper limit for salt content in flat bread (pita or Arabic bread) at 0.5% is strongly recommended. However, salt levels at ≤ 1% would be appropriate for other kind of breads.

Evaluation of a Mass-Media Campaign to Increase the Awareness of the Need to Reduce Discretionary Salt Use in the South African Population.

The South African strategic plan to reduce cardiovascular disease (CVD) includes reducing population salt intake to less than 5 g/day. A mass media campaign was undertaken to increase public awareness of the association between high salt intake, blood pressure and CVD, and focused on the reduction of discretionary salt intake. Community based surveys, before and after the campaign, were conducted in a cohort of black women aged 18–55 years. Questions on knowledge, attitudes and beliefs regarding salt use were asked. Current interest in engaging with salt reduction behaviors was assessed using the “stage of change” model. Five hundred fifty women participated in the baseline study and 477 in the follow-up survey. Most of the indicators of knowledge, attitudes and behavior change show a significant move towards considering and initiating reduced salt consumption. Post intervention, significantly more participants reported that they were taking steps to control salt intake (38% increased to 59.5%, p < 0.0001). In particular, adding salt while cooking and at the table occurred significantly less frequently. The findings suggest that mass media campaigns may be an effective tool to use as part of a strategy to reduce discretionary consumption of salt among the population along with other methods.

Estimating population salt intake in India using spot urine samples.

To compare estimates of mean population salt intake in North and South India derived from spot urine samples versus 24-h urine collections. In a cross-sectional survey, participants were sampled from slum, urban and rural communities in North and in South India. Participants provided 24-h urine collections, and random morning spot urine samples. Salt intake was estimated from the spot urine samples using a series of established estimating equations. Salt intake data from the 24-h urine collections and spot urine equations were weighted to provide estimates of salt intake for Delhi and Haryana, and Andhra Pradesh. A total of 957 individuals provided a complete 24-h urine collection and a spot urine sample. Weighted mean salt intake based on the 24-h urine collection, was 8.59 (95% confidence interval 7.73-9.45) and 9.46 g/day (8.95-9.96) in Delhi and Haryana, and Andhra Pradesh, respectively. Corresponding estimates based on the Tanaka equation [9.04 (8.63-9.45) and 9.79 g/day (9.62-9.96) for Delhi and Haryana, and Andhra Pradesh, respectively], the Mage equation [8.80 (7.67-9.94) and 10.19 g/day (95% CI 9.59-10.79)], the INTERSALT equation [7.99 (7.61-8.37) and 8.64 g/day (8.04-9.23)] and the INTERSALT equation with potassium [8.13 (7.74-8.52) and 8.81 g/day (8.16-9.46)] were all within 1 g/day of the estimate based upon 24-h collections. For the Toft equation, estimates were 1-2 g/day higher [9.94 (9.24-10.64) and 10.69 g/day (9.44-11.93)] and for the Kawasaki equation they were 3-4 g/day higher [12.14 (11.30-12.97) and 13.64 g/day (13.15-14.12)]. In urban and rural areas in North and South India, most spot urine-based equations provided reasonable estimates of mean population salt intake. Equations that did not provide good estimates may have failed because specimen collection was not aligned with the original method.

Effects of a nationwide strategy to reduce salt intake in Samoa.

Objective:Salt reduction is one of the most cost-effective interventions for the prevention of noncommunicable diseases, but there are no studies evaluating the effectiveness of national strategies in low or lower middle income countries. This study aimed to examine the effect of an 18-month nation-wide salt reduction strategy in Samoa.Methods:Two nationally representative cross-sectional surveys of adults aged 18–64 years, measuring 24-h urinary salt excretion and salt-related knowledge, attitudes and behaviours, were conducted before (2013) and after (2015) the intervention.Results:There were 234 participants at baseline (response rate 47%) and 479 at 18 months (response rate 61%). There was no change in mean population salt intake between 2013 (7.31 g/day) and 2015 (7.50 g/day) (0.19, 95% confidence interval −0.50 to 0.88; P = 0.588). There were significant changes in the proportion of the population who always or often add discretionary salt when eating (−16.2%, P = 0.002), the proportion who understood the adverse effects of salt (+9.0%, P = 0.049) and the proportion using one or more methods to control their salt intake (+20.9%, P < 0.001). A total of 73% reported that they had heard or seen the salt reduction messages.Conclusion:With widespread awareness of the salt reduction message and some improvements in salt-related knowledge and behaviours following the intervention, Samoa is now well positioned to implement much-needed structural initiatives or policies to reduce salt in the food supply.